Remote CA Utilization Review Nurse - RN/LVN

Astrana Health, Inc.; Monterey Park (CA); Remote; USD 47,000 - 65,000; Full time

Job summary

Astrana Health is seeking a CA-licensed Utilization Review Nurse to support the Health Services Department. You will review outpatient services for medical necessity, perform prior authorizations, and refer cases to Medical Directors as needed.

This is a remote role for CA-licensed RNs/LVNs, with candidates living in California; office is in Monterey Park, CA, and occasional hybrid work may be required within 30 miles.

Qualifications

• Active and unrestricted CA LVN or RN license.
• Outpatient Utilization Management experience.
• Two years of health plan, IPA or MSO experience.
• Proficient with Microsoft Word, Excel and Outlook.

Responsibilities

• Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services and durable medical equipment.
• Refer cases to Medical Directors as needed/appropriate.
• Maintain knowledge of state and federal regulations and accreditation standards.
• Comply with internal policies and procedures.
• Perform any other job duties as requested.

Skills

Interpersonal skills

Collaboration

Staff training

Education

California LVN or RN license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Astrana Health is seeking a CA-licensed Utilization Review Nurse to support the Health Services Department. You will review outpatient services for medical necessity, perform prior authorizations, and refer cases to Medical Directors as needed.

This is a remote role for CA-licensed RNs/LVNs, with candidates living in California; office is in Monterey Park, CA, and occasional hybrid work may be required within 30 miles.